Opinion: The Vaccination Debate and the Importance of Framing

Tracy Wang

As of February 6th, six Torontonians had been diagnosed with the measles virus. Of those six individuals, three were not vaccinated, one received only one of the two recommended doses of the vaccine, and the remaining two should have been immune (one was fully vaccinated and the other was born before 1970). While most domestic cases of measles result from Canadians travelling abroad, Toronto Public Health has found no personal or travel connections between the affected individuals, and has not been able to identify the source of the infection. This suggests that the highly contagious measles virus was contracted in Toronto, a troubling sign that there may be a bigger outbreak to come.

Toronto’s mini-outbreak follows a much larger American trend, where 102 people in 14 states have been diagnosed with measles following a recent outbreak at Disneyland Resort in California. While the anti-vaccination movement in the United States is probably not single-handedly responsible for the recent spread of the virus, the vaccination debate has certainly seen a resurgence in both public and policy discourse.

Numerous surveys have shown that parents who delay or refuse vaccination for their children are more likely to believe that vaccines could have serious side effects, including autism, or that children are already overmedicated. Despite significant and growing evidence against these claims (including a retraction of the original study linking autism to vaccines), the anti-vaccination movement has continued to passionately defend its position and to garner public support. The strength of this movement points to the power of effective framing: in this case, that choosing not to vaccinate is a parent’s right to protect his/her child’s future. For anti-vaccinators, the issue is one of individual rights rather than that of public health.

The precise size of the anti-vaccination movement in North America is unknown; but if vaccine exemption rates are any indication, more and more parents are opting out of vaccinating their children. A study published in the New England Journal of Medicine found that in states with limited exemption criteria, vaccine exemption rates increased by 13 per cent per year between 2005 and 2011.

At its roots, the anti-vaccination movement sends a message of empowerment. Parents coping with the diagnosis of a poorly understood illness or disorder such as autism are effectively given a lightning rod for blame, from which follows a clear plan of action: “If vaccines carry such significant risk, I can choose not to vaccinate and protect my child.” This justification is consistent with rational choice theory – that is, that individuals act in their own best interests – and invokes a number of ideologies surrounding personal freedom, autonomy, and morality. Throw in medical jargon like “thiomersal” (a preservative that contains mercury) or “aluminum salts”, and it is clear that the anti-vaccination movement’s frame is one that also exploits fear and confusion.

Now, contrast the above with the framing used by those who advocate for vaccinations. Public health officials, doctors, and politicians are often among the primary proponents of vaccination as a means of protection for the greater community. By maintaining a 95 per cent vaccination rate (as recommended by the Public Health Agency of Canada), herd immunity protects everyone, as diseases need hosts to survive. To put it simply: if the majority of people are vaccinated, then the host pool is depleted, and there are fewer susceptible people to spread the disease. This is especially important for individuals who cannot receive vaccinations and are particularly vulnerable to infection – including those with certain allergies, compromised immune systems, or the very young.

The framing of the issue in this case draws on evidence, fact, and history. Yet science alone fails to strike at the powerful frames of personal choice and morality that the anti-vaccination movement has successfully put to use. In fact, a study in Scientific American found that when researchers taught parents that vaccines and autism were not linked, the parents were actually less likely to vaccinate their children.

Advocates of vaccinations could perhaps make use of a more effective frame of social responsibility and altruism: “By vaccinating your child, you’re also protecting mine.” A letter penned by novelist Roald Dahl 27 years ago calling on parents to vaccinate their children has recently resurfaced, and captures a certain emotional weight that is missing from similar calls by officials ranging from Ontario’s Health Minister Eric Hoskins to American President Barack Obama. If politicians and public health officials across North America plan to continue to encourage parents to vaccinate, and want to really succeed in doing so, perhaps it is time to shift from convincing citizens’ minds to appealing to their hearts.

For now, the six measles cases in Toronto are isolated, and Minister Hoskins has stressed that Ontarians need “not be alarmed.” According to Dr. Natasha Crowcroft, Chief of Infectious Diseases for Public Health Ontario, the overall vaccination rate for measles in Ontario is 97 percent, although Minister Hoskins has noted that only 88 per cent of seven-year-olds in Ontario are vaccinated. Scientists at the University of Toronto have warned that if vaccination rates drop by a mere 10 per cent, the city may face an outbreak of as many as 50,000 measles cases in less than five years. With many Toronto schools currently falling short of the target vaccination rate needed to maintain herd immunity, there is risk for a larger outbreak. Let us hope that it doesn’t take a child dying a preventable death to bring more parents to vaccinate their children.

Tracy Wang is a 2016 Master of Public Policy candidate at the University of Toronto’s School of Public Policy and Governance.  She holds a Bachelor of Arts and Science from McGill University, where she completed a major in Cell and Molecular Biology and a double minor in English Literature and Economics. Tracy is particularly interested in health policy, but looks to also explore economic and education policy further.

[Image: Getty, UIG]